1. Transactions and Code Sets and the National Provider Identifier (NPI) – Getting Value From the HIPAA Standards
Presented by:
Steven S. Lazarus, PhD, CPEHR, CPHIT, FHIMSS
Boundary Information Group
Health IT Certification, LLC
March 29, 2007

2. Strategic IT business process planning
ROI/benefits realization
Project management and oversight
Workflow redesign
Education and training
Vendor selection and enhanced use of vendor products
Facilitate collaborations among organizations to share/exchange health care information
EHR and RHIO training and facilitation
Steve Lazarus, Boundary Information Group Health IT Certification, LLC Strategies for workflow, productivity, quality and patient satisfaction improvement through health care information
Business process consultant focusing on electronic health records, and electronic transactions between organizations
Former positions with MGMA, University of Denver, Dartmouth College
Active leader in the Workgroup for Electronic Data Interchange (WEDI)
Speaker and author (two books on HIPAA Security and one on electronic health records)
Recipient of the HIMSS 2006 Book of the Year Award
Recipient of Vision and Leadership as WEDI Chairman, WEDI Corporate Leadership Award, and WEDI Distinguished Service awards

3. Agenda CAQH CORE WEDI HSA Task Group Financial Institutions
TCS Issues for

4. 1. CAQH CORE Committee on Operating Rules for Information Exchange
Adding operating rules to X12 transactions
Achieve Interoperability
Add value
Phase I Rules 2006
Eligibility – Promote real-time, data content
Data exchange infrastructure – Internet, security, response time, system availability
Certification
CCHIT ambulatory EHR and HITSP consumer empowerment

5. 1. CAQH CORE CAQH CORE Phase II Patient identification Data content
Connectivity
Certification

6. 2. WEDI HSA Task Group Started 2005 Task group addressing:
Three business models to define business requirements
Workflow
Information flow
Educational needs of providers and patients
Education forums planned for
Recommendations will include transactions
Participants include providers, vendors, consultants, health plans, and financial institutions

7. 3. Financial Institutions
Growing interest in 835 remittance advice and business process
Electronic funds transfer
EHNAC has new criteria for financial services

8. 4. Transactions and Code Set Issues for 2007-2012
Faster change process needed
Support HDHP and HSA business needs
Web services
Use of Internet (including Medicare)
Real-time for transactions and data source updates
Tools to manage the real-time messages (administrative and clinical)
Consumers and providers needs for accurate, timely information

9. 4. Action Steps for the Industry
Be involved in CORE and WEDI
Change the transactions, code set and identifier development and implementation process so that administrative transactions support business needs as needed
Medicare must promote Internet, real-time use that is compatible with provider business processes

10. Contact Information
Steven S. Lazarus, PhD, CPEHR, CPHIT, FHIMSS
Boundary Information Group, President
Health IT Certification, Co-Founder
4401 South Quebec Street, Suite 100
Denver, CO
(303)